Analysis has extended its scope beyond psychoneurosis, for which it is the 'causal [primary] treatment'. But in states such as delinquency, psychopathy, and character disorder we deal with processes other than repression and the return of the repressed. It is by no means clear that analysis is the treatment of choice, or effective treatment at all, in such cases. In its struggle against the appearance of a neurosis, the ego pays one or another price in ego distortion, and this price manifests itself in various ways.